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POLICY FORUM2014 Enhancing Nutrition Security Via India’S National Food Security Act: Using an Axe Instead of a Scalpel?

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POLICY FORUM2014 Enhancing Nutrition Security Via India’S National Food Security Act: Using an Axe Instead of a Scalpel? POLICY FORUM2014 Enhancing Nutrition Security via India’s National Food Security Act: Using an Axe instead of a Scalpel? Sonalde Desai National Council of Applied Economic Research and University of Maryland Reeve Vanneman University of Maryland India Policy Forum July 15–16, 2014 NCAER | National Council of Applied Economic Research 11 IP Estate, New Delhi 110002 Tel: +91-11-23379861–63, www.ncaer.org NCAER | Quality . Relevance . Impact Enhancing Nutrition Security via India’s National Food Security Act: Using an Axe instead of a Scalpel?* Sonalde Desai** National Council of Applied Economic Research and University of Maryland Reeve Vanneman*** University of Maryland India Policy Forum July 15–16, 2014 Abstract In September 2013, India passed a historic National Food Security Act. This paper examines the potential impact of the two central pillars of this act - expansion of the Public Distribution System and strengthening of the Integrated Child Development Schemes – on child nutrition. Using new data from the India Human Development Survey of 2011-12, this paper shows that access to subsidized grains via PDS is not related to improved child nutrition, and while ICDS seems to be related to lower child undernutrition, it has a limited reach in spite of the universalization of the program. The paper suggests that a tiered strategy in dealing with child undernutrition that starts with the identification of undernourished children and districts and follows through with different strategies for dealing with severe, acute malnutrition, followed by a focus on moderate malnutrition, could be more effective than the existing focus on cereal distribution rooted in the NFSA. JEL classification: I12, I15, I38, O15. Keywords: Malnutrition, Child health, Food security, Public distribution system, ICDS. *Preliminary draft. Please do not circulate beyond the NCAER’s preparations for the India Policy Forum 2014, for which this paper has been prepared. ** [email protected] *** [email protected] Sonalde Desai and Reeve Vanneman 1 1. Introduction1 ational Food Security Act (NFSA) passed in September 2013 is one of the largest safety net programs in the world. This act legislates the availability of 5 N kilograms of cereals per person per month at prices ranging from 1 to 3 Rs. Per kg to about 67% of India’s population. It also contains provisions for nutritional supplementation for young children as well as pregnant and lactating mothers via the Integrated Child Development Scheme (ICDS) and through maternity benefit of Rs. 10,000 for all new mothers.2 The maternity benefits are not yet implemented due to a court challenge but the other two programs involve expansion/restructuring of currently existing programs. The financial cost of this extremely ambitious program is difficult to estimate but some estimates peg it at Rs. 44,000 to 76,000 crore (Mishra 2013) above and beyond the costs already being incurred for various food security programs. This act has emerged in response to a strong advocacy following the observation that economic growth has not kept pace with reduction in hunger and malnutrition in India. In 2013, India ranked 63rd out of 120 in the Global Hunger Index. This index is based on proportion of people who do not get sufficient calories, proportion of children who are underweight and mortality rate for children under five (von Grebmer, Headey et al. 2013). Much of this low ranking is driven by very high proportion of underweight children in India. National Family Health Survey of 2005-6 shows that 43 percent of children under 5 are underweight compared to WHO global standards and 48 percent are too short for their age (have moderate to severe stunting). Research on consequences of undernutrition notes substantial economic costs associated with poor learning outcomes and productivity (Spears 2012, Spears 2013). By some estimates, the economic burden of malnutrition is expected to be between 0.8 to 2.5% of the GDP (Crosby, Jayasinghe et al. 2013). One can easily quibble about the size of these estimates but these eye-catching numbers have given considerable impetus to the advocacy for reducing malnutrition and placed it at the forefront of the national political agenda. For example, the election manifesto of the Bharatiya Janata Party prioritizes a focus on undernutrition in a mission mode. While a nutrition advocacy has fueled the demand for NFSA, whether the NFSA will meet the nutritional needs of the nation remains far from clear. In order to assess its potential implications we must address the following questions: 1. What are the determinants of undernutrition in India and does NFSA appropriately target them? 2. How successful are the two mechanisms at the core of NFSA – PDS and ICDS – in targeting undernutrition? Are there any unanticipated effects? 1This paper uses data from the NCAER/Maryland India Human Development Survey, which was funded by grants R01HD041455 and R01HD061048 from the US National Institutes of Health and a supplementary grant from the Ford Foundation. Data management was funded by the UK Government as part of its Knowledge Partnership Programme and analysis was carried out with the aid of a grant from the International Development Research Centre, Ottawa, Canada. We gratefully acknowledge research assistance from Jaya Koti. This work benefitted from discussions with participants at a NCAER/IDS Manesar Conference on Undernutrition in India and Public Policy in June 2014. 2 For the text of the Act see, http://indiacode.nic.in/acts-in-pdf/202013.pdf. 2 India Policy Forum 2014 3. What is the likelihood that the massive expansion of programs envisioned by NFSA can be carried out within the present administrative framework? 4. Should we be looking at any other policy options? 2. Current Status of Undernutrition in India Given the policy activism surrounding food and hunger, it is surprising that India has so little recent data on nutritional status. Generally malnutrition is measured by collecting data on height and weight for children and adults. Based on these, anthropometric indices are calculated reflecting standardized scores for weight-for-age or height-for-age comparing the index individual with a reference standard. 3 For adults the body-mass-index is usually used. Children with weight-for-age index of that is 2 standard deviations or more below the median of the reference population are generally considered underweight while those below 3 standard deviations are considered severely underweight. Similarly children with height-for-age of below 2 standard deviations are considered stunted and those below 3 standard deviations are considered severely stunted. 2.1. Sources of Nutrition Data in India Getting national data on child anthropometry is quite difficult because not only does it involve measuring children, it also involves collecting accurate data on their age since children grow rapidly and a few months’ difference in age could make a large impact on their placement on the growth chart. We have three major sources of data on nutrition: 1. National Family Health Surveys (NFHS) of about 100,000 women conducted in 1992-93, 1998-99 and 2005-6 are the most frequently used sources of nutrition data. This survey was organised by the International Institute of Population Sciences which also conducted the District Level Health Survey (DLHS-II) of 2002-4 of about 200,000 households. District Level Health Survey (DLHS-IV) of 2011-12 was carried out for only selected states but offers the latest data on undernutrition with large samples. 2. Periodic surveys conducted by National Nutrition Monitoring Board (NNMB) covering anthropometric outcomes and dietary intake for rural areas of 10 states in 1975-79, 1988-90, 1996-97 and 2011-12. The sample size for these surveys is about 24000 households. NNMB also carries several other special purpose surveys including those in tribal areas. 3. Some of the special surveys with anthropometric data include the HUNGaMA survey of 2011-12 in rural areas of 100 poorest districts of seven states carried out by the Nandi Foundation for over 100,000 children and India Human Development Surveys (2004-5 and 2011-12) of about 42000 households. 3 Whether use of global standards is appropriate in India is subject to considerable debate, see Panagariya (2013) and articles in response to this including Deaton et al. (2013) and Desai and Thorat (2013). Since a fourth of the WHO sample from which these standards were derived consists of Indian children, and these standards have been officially adopted by Indian Academy of Pediatrics as well as over 150 countries worldwide, we do not focus on this debate in this paper. Sonalde Desai and Reeve Vanneman 3 Sadly none of the large nationally representative surveys are recent. But Figure 1 based on NFHS, NNMB and IHDS surveys paints a picture of modest decline in proportion of children underweight during an era when poverty dropped sharply. The HUNGaMA survey suggests a sharper decline when compared the DLHS-II survey for the same districts using the same reference standards (from 53% children being underweight in DLHS of 2002-4 to 42% underweight in HUNGaMA survey of 2011-12 but these comparisons are somewhat difficult due to different survey design and focus on 100 poorest districts. No other national data are currently available. The Annual Health Survey (still being processed) collects anthropometric data for 9 focus states in north-central India, while the District Level Health Survey IV collects data in the rest of the India and fact sheets form DLHS-IV for selected states are just being put in the public domain. 2.2. State of Undernutrition in India The IHDS of 2011-12 on which most of the discussion in this paper is based, is the only source of national data on anthropometry as well as dietary intake/ expenditure and utilization of large public programmes like ICDS and PDS.
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